Private Payers Don’t Want To Play Meaningful Use Games

Today, health IT writer Neil Versel tweeted an interesting observation:

It is indeed interesting to note that while private payers have encouraged physicians to engage in some forms of electronic communication (notably electronic claims adjudication), they’re not setting up their own mini-Meaningful-Use programs.

Now, they are pushing for business models, such as ACOs and the medical home, which require smart use of EMRs. But to my knowledge, few if any health plans have gotten into a tug of war with with providers as to how they use their EMRs, or offered incentives for using an EMR in any specific way.

There’s clearly a reason for that. So what conclusion can we draw from the lack of Meaningful Use-style demands by payers?

Just this — that payers feel their money is better spent on rewarding positive care outcomes and efficiency.

Pay for performance programs have been in place for quite some time now, and evidence is accumulating that they’re effective. According to the Health Care Incentives Improvement Institute, its Bridges To Excellence-recognized physicians have been found to:

  • Outperform non-recognized physicians on process measures of quality.
  • Have fewer episodes per patient and lower resource use per episode.
  • Have lower average costs per patient and per episode.

Clearly, payers have gotten interested in HIEs; data in the aggregate definitely serves their needs. But when it comes to EMRs, they don’t get as excited. So far, the evidence that EMRs can achieve these kind of quality improvements are scattered at best, though there are some promising signs emerging.

Bottom line, payers don’t seem to care much just how engaged providers are in using EMRs, as long as the provider does enough to make entities like medical homes work. The specifics of how providers use EMRs don’t seem like something they’re worrying about.

I’m not suggesting that Meaningful Use programs are a bad idea — it often takes government to do needful things that the private sector can’t or won’t touch — but the fact that payers aren’t pushing something similar does make you think, doesn’t it?

About the author

Anne Zieger

Anne Zieger

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.